Building a high quality health service for a healthier Ireland

Building a high quality health service for a healthier Ireland Health Service Executive Corporate Plan 2015-2017

Contents Foreword from the Director General 2 Vision and Mission 3 Values 4 Our Plan 5 Goals 6 Future Health Service Delivery Model 16 Conclusion 16 Health Service Executive Corporate Plan 2015-2017 1

Foreword from the Director General Our Corporate Plan sets out how we aim to improve the health service over the next three years. We want to provide a health service which becomes world class, is available to people where they need it and when they need it. It should provide people with the very best outcomes which can be achieved, as this is what everyone who uses our services expects. We have therefore set ambitious goals and priorities which will stretch us. We may not be able to achieve all of them but we will certainly make every effort to do so. Our resilience will stand to us The impact of the downturn in our economy over the last number of years has been very difficult for everyone. This was no different for our health services, for those using our services and the staff providing them. It has been challenging for all of us to do more with less. I particularly want to recognise our staff for their resilience and perseverance. I am hopeful that we are starting on a more positive journey, one where economic recovery is showing improved signs of a more stable financial environment for health in 2015 and beyond. Life expectancy has increased Life expectancy in Ireland has increased and is above the EU average. We are living longer through advances in medicine, technology and improved models of care. Our population is ageing with those over 65 years increasing by almost 10% (over 58,000 people) over the course of this plan. Those over 85 years will increase by 12% (7,822 people). These are very positive and welcome trends. However, we know the prevalence of chronic disease increases with age. Three quarters of all deaths in Ireland are due to three chronic illnesses cardiovascular disease, respiratory disease and cancer. We must all play our part in reducing these rates. People will be at the centre of how we deliver services People must have trust and confidence in our services. We want to deliver services which help keep people well and those who use them must be at the centre of what we do. Our model of care will ensure our services are integrated across hospitals and communities to make it easier for people to access them no matter where they live. Our focus will be on reform and better outcomes We have established Hospital Groups and are establishing Community Healthcare Organisations to help us deliver an integrated quality model of care. The National Integrated Care Programmes will lead improvements in clinical and quality care across the Hospital Groups and Community Healthcare Organisations in an integrated way. Working with our colleagues, partners in the voluntary sector and policy makers we will continue to evaluate and reform how we deliver our health services over the coming years to ensure we get best outcomes and best value for money. Our values bind us together We will try to live our Values of Care, Compassion, Trust and Learning every day and in all that we do. Our values influence our attitudes and behaviour towards those to whom we provide services and with whom we have professional contact. We must be more open to learning from our past mistakes and innovative in our drive for continuous improvement. We must prove our commitment to these values when things go wrong. Our vision sets out our ambition Our Vision sets out what we want to achieve and how we will organise and deliver our services over the period of the plan. This plan does not set out in detail all we intend to do but gives a broad sense of where we are going and what we want to achieve. Each year the detail of what we will do will be set out in our annual National Service Plan. Our ability to deliver on the full range of ambitions set out in this plan in some cases is dependent on additional funding and or changes in policy and legislation. However, there is still a lot we can do within our existing resources. The future is not without challenges. However, it also brings with it opportunities to work together towards a healthier Ireland with high quality health services valued by all. Tony O Brien Director General 2 Health Service Executive Corporate Plan 2015-2017

Vision A healthier Ireland with a high quality health service valued by all Mission People in Ireland are supported by health and social care services to achieve their full potential People in Ireland can access safe, compassionate and quality care when they need it People in Ireland can be confident that we will deliver the best health outcomes and value through optimising our resources Health Service Executive Corporate Plan 2015-2017 3

Values Care We will provide care that is of the highest quality We will deliver evidence based best practice We will listen to the views and opinions of our patients and service users and consider them in how we plan and deliver our services Compassion We will show respect, kindness, consideration and empathy in our communication and interaction with people We will be courteous and open in our communication with people and recognise their fundamental worth We will provide services with dignity and demonstrate professionalism at all times Trust We will provide services in which people have trust and confidence We will be open and transparent in how we provide services We will show honesty, integrity, consistency and accountability in decisions and actions Learning We will foster learning, innovation and creativity We will support and encourage our workforce to achieve their full potential We will acknowledge when something is wrong, apologise for it, take corrective action and learn from it We will try to live our values every day and will continue to develop them over the course of this plan 4 Health Service Executive Corporate Plan 2015-2017

Our Plan This Corporate Plan sets out our 5 goals, the actions required to deliver them and how we will measure success Goal 1 Goal 2 Goal 3 Goal 4 Goal 5 Promote health and wellbeing as part of everything we do so that people will be healthier Provide fair, equitable and timely access to quality, safe health services that people need Foster a culture that is honest, compassionate, transparent and accountable Engage, develop and value our workforce to deliver the best possible care and services to the people who depend on them Manage resources in a way that delivers best health outcomes, improves people s experience of using the service and demonstrates value for money Health Service Executive Corporate Plan 2015-2017 5

Goal 1 Promote health and wellbeing as part of everything we do so that people will be healthier We want people to live fulfilled lives and to be as healthy as they can. We want the health service to have a positive impact on the health and wellbeing of everyone living in Ireland. We will support people to be as healthy as they can by promoting healthy lifestyle choices. Our Ambition We will assess the health needs of our population and develop programmes designed to meet those needs and promote good physical and mental health. We will do this across all stages of life from pregnancy, childhood, adolescence, adulthood and into old age. We will work with all relevant organisations to address the social, economic and environmental factors that give rise to poor physical and mental health and to address inequalities. To deliver on our ambition, we will focus our efforts on five priority areas which are: increasing physical exercise, encouraging healthy eating, reducing smoking and alcohol consumption and empowering people to develop a positive sense of wellbeing. demonstrate that changing our lifestyle behaviour makes a significant difference in reducing and preventing these chronic diseases. It is our aim to support people to do this by helping them to adopt healthier lifestyle choices. In addition, we will continue to expand our screening programme to diagnose and detect illnesses and to treat them at the earliest opportunity. For our children, we will protect them from common childhood diseases and infection through immunisation programmes and developmental health checks. For those in society who have care needs, we will support them to live as independently as they can, including older persons and people with disabilities, by providing a range of supports suited to their individual needs. We know that three quarters of deaths in Ireland are due to three chronic diseases cancer, cardiovascular and respiratory diseases. There is strong evidence to 6 Health Service Executive Corporate Plan 2015-2017

What We Will Do Implement Healthy Ireland strategy across our organisation and services (available from www.health.gov.ie/healthy-ireland/) Integrate prevention, early detection and self management into the Integrated Care Programmes Reduce chronic disease by focusing on areas such as diet, nutrition and physical activity, obesity, tobacco, alcohol and substance misuse Increased levels of supported living in local communities Improved compliance with Safeguarding Vulnerable Persons at Risk of Abuse Policy Increased uptake rate for childhood immunisation to 95% Increased uptake rate for human papillomavirus (HPV) immunisation to 85% National Framework for Suicide Prevention implemented Support and encourage our staff to look after their own health and wellbeing Promote positive mental health, positive ageing and good sexual health Deliver and expand our screening programmes, including breast, cervical, bowel and diabetic retinopathy screening Deliver person centred community based services which support independence and choice for older people and people with disabilities Implement a child screening model and improve national immunisation rates Implement programmes to reduce healthcare acquired infections How We Measure Success Reduced prevalence of smoking to <15% of the population 3% increase in the number of people within a healthy weight range Amount of alcohol consumed each year by people aged 15 years and over reduced by 0.5 litres of pure alcohol BreastCheck: Increase uptake rate of >70% of women aged 50-64 who have had a mammogram CervicalCheck: Achieve 80% coverage of eligible women within the screening programme BowelScreen: Achieve 60% uptake rate of eligible people within the screening programme Diabetic RetinaScreen: Achieve 80% uptake rate of eligible individuals within the screening programme Less people with a disability living in congregated group residential settings 96% of the population over 65 years supported to live independently in their own home What We Now Know Chronic disease will rise by 4% each year 1 in 5 of us will experience mental health problems in our lifetime 1 in every 10 people over 50 years of age has diabetes 1 in 5 children are overweight 3 in 5 adults are overweight Cancer will rise by 4% each year 36,000 new cases of cancer are diagnosed each year 500,000 people are living with a serious lung disease 19.5% of the population smoke Health Service Executive Corporate Plan 2015-2017 7

Goal 2 Provide fair, equitable and timely access to quality, safe health services that people need We must make it easy for people to access the services they need. These services must compare with the best other countries have to offer and be safe and available to people in the right place and when they need them. Our Ambition We will provide quality community and primary care services, which are easily accessible and close to where people live. It is our aim to provide 95% of all care in the community, outside of acute hospitals. We will develop alternative models of care across the entire health system to avoid the need for people to attend hospitals so that they can be treated in the community in a timely and responsive manner. We will deliver care around the individual patient and service user and put the patient at the heart of what we do. We will do this by developing a modern model of integrated care across our hospital and community services so that people are treated appropriately and conveniently to where they live. Our ultimate aim is that people will only go to hospital when they need to but that when they do, they can access the services they need whether as an outpatient or an inpatient without the need to wait for long periods of time. For those with mental health conditions, we will provide integrated mental health services as far as possible in community settings and in age appropriate locations. We will improve our waiting times for children and adolescents who need assessment and treatment. For the users of our disability services, we will provide integrated services that meet the highest standards, where people are treated with respect and dignity and can live as independently as possible. We will support older people by providing a range of services including home care, day care, respite care, short stay care and rehabilitation which will avoid the need for admission to hospital. For those who need hospital care, we will support their early discharge from hospital by providing step down care, home care supports and therapy services. When required, we will provide timely access to long term care. In emergency situations people will also need to access ambulance services. Our aim for the future is for our highly trained ambulance staff to provide the appropriate treatment to people either over the phone (Hear and Treat), at the scene (Treat and Discharge) or in transferring patients to hospital. We will continue to train our ambulance staff to the best international standards. 8 Health Service Executive Corporate Plan 2015-2017

What We Will Do Strengthen primary care services including general practice access to diagnostic services such as radiography and ultrasound Extend access to general practice care without fees in line with government policy Develop a new General Practitioner contract Expand the coverage and services of Community Intervention Teams Develop close working relationships between specialists in our hospitals and primary care physicians which allows ease of access to specialist advice for patient management Improve access to hospital, outpatient and community services and reduce wait times Implement a number of key Integrated Care Programmes including older persons, chronic disease prevention and management, child and maternal health, and improve patient flow Develop programmes to improve the quality and safety of mental health services for adults, children and adolescents Provide a range of home and community supports to enable older people to live independently for as long as possible Develop services for people with a disability so that they are supported to participate in society and reach their full potential Provide palliative care services and compassionate end of life care Drive the significant changes required in the National Ambulance Service in line with best practice standards Facilitate improved access to services for marginalised groups How We Measure Success General practice care free at point of access for children under 6 years and people over 70 and plans in place in line with Government policy General Practitioner contract implemented Minor surgery provided in primary care settings and direct access to diagnostics Patients and service users are involved in developing their own care plan Clear and comparable information and advice available to support individuals and their families in choices around service provision 100% of patients receive their day case or inpatient procedure within 5 months of referral 100% of patients receive a first outpatient appointment within 8 months of referral Improved timely discharge from hospital when acute care is complete 100% of patients who do not require observation are admitted, transferred or discharged within 6 hours of their arrival in the Emergency Department Diagnostic test received by 99% of patients who require it within 2 months from referral 95% of patients referred urgently with breast symptoms (where cancer is initially suspected) wait no longer than 2 weeks for a first outpatient appointment 95% of patients are seen within 10 working days after an urgent referral to a lung rapid access clinic 90% of patients are seen within 2 weeks after an urgent referral to a prostate rapid access clinic 95% of patients start treatment within 2 weeks of diagnosis for all cancers 100% of patients referred urgently for a colonoscopy wait no longer than 4 weeks for an appointment 100% of patients referred for a routine colonoscopy or gastroscopy wait no longer than 13 weeks for an appointment 100% of patients who have had their operation cancelled for non-clinical reasons offered another scheduled surgery date within 28 days No urgent operation to be cancelled a second time 95% of children and adolescents, requiring admission to a child and adolescent acute mental health inpatient bed, admitted to an age appropriate inpatient unit 95% of all accepted referrals to a mental health service will be seen by a Mental Health Team for a first appointment within 8 weeks 80% of ECHO (life-threatening cardiac or respiratory arrest) and DELTA (life-threatening illness or injury, other than cardiac or respiratory arrest) ambulance calls resulting in an emergency response within 18 minutes and 59 seconds All handovers between ambulances and Emergency Departments take place within 30 minutes Improved rate of return of spontaneous circulation (ROSC) in out of hospital cardiac arrest patients who have received pre-hospital care through the National Ambulance Service What We Now Know 939,600 contacts with general practice out of hours services annually 290,000 emergency calls are received by the national ambulance service each year 10.3 million home help hours are delivered every year to help older people remain at home 3,329 people received care in acute adult inpatient mental health units in 2014 1.4 million people receive care across 48 hospitals each year 3 million people have a consultation with a clinician as an outpatient each year 1.2 million people receive care in Emergency Departments each year 94% of urgent breast cancer referrals are seen within 2 weeks 96% of people who need inpatient palliative care are admitted within 7 days Health Service Executive Corporate Plan 2015-2017 9

Goal 3 Foster a culture that is honest, compassionate, transparent and accountable We will provide health and personal social services with care and compassion. This includes being honest and open with our patients, those using our services, the public and our staff. Our Ambition We will listen with respect, kindness, consideration and empathy to patients, service users and carers when planning and delivering services. We want people with mental and physical health conditions to have a positive experience of hospital, primary and community based care. Through improved communication and engagement, our aim is to build open, respectful and trusting professional relationships with our patients and service users. We will enhance the information that we provide to patients and service users to enable them make choices for their care. We will listen to patients, service users and our staff to learn about their experience of care and make improvements to our services. We will enable patients to provide real time feedback on the quality of services which staff can use to make practical and timely improvements to the services they provide. Core to this goal is ensuring that people s experience of care is not only safe and of high quality, but also person centred, caring and compassionate. We will put in place systems to reduce the possibility of human error and avoidable harm to patients, service users, the public and staff. When things go wrong, as they sometimes do, we will acknowledge it in a timely manner, apologise for it, respond to it with compassion, kindness and empathy, take corrective action and ensure we learn from it to reduce the risk as much as possible of it happening again. 10 Health Service Executive Corporate Plan 2015-2017

What We Will Do Conduct a service user and patient experience survey annually in each hospital and community service Enhance our engagement with patients and service users, their families and carers and involve them in the design and delivery of services Promote You and Your Health Service, our patient charter that outlines what patients and service users can expect from our health service and what our health service can expect from them Improve feedback systems and arrangements so that service users and patients can readily make a comment, compliment or complaint Strengthen governance arrangements through the HSE s Accountability Framework to improve performance Develop a report on a new suite of quality and outcome indicators for all services Publish information on our performance results Foster a fair and just culture within healthcare by continuing to implement policies such as Open Disclosure and Good Faith Reporting Encourage the public and staff to highlight issues of concern in an open manner Respond to HSE reports and reports from regulators in a timely and open manner Put processes in place so that all safety incidents will be effectively managed, reported, investigated and the learning from such incidents is shared and implemented Undertake clinical audit to drive quality service improvements Support development and implementation of national guidelines and models of care including National Clinical Effectiveness Committee (NCEC) guidelines Continue to implement the National Standards for Safer Better Healthcare How We Measure Success Rates of service user engagement and feedback increased Open Disclosure and Good Faith Reporting policies implemented in every healthcare setting Performance Accountability Framework fully implemented and rigorously monitored Increase the number of Clinical Audits conducted Agreed actions and recommendations from HSE reports and reports from regulators monitored and implemented All serious incidents and events reported, managed and investigated in a timely manner What We Now Know 6,179 compliments were recorded and 8,375 complaints were received in 2014 5,407 parliamentary questions and 7,466 Freedom of Information requests received in 2014 Approximately 100,000 incidents across the health service are reported annually to the State Claims Agency 1.084bn in claims are outstanding through the State Claims Agency at the end of 2013. Patients and their families have reported to us that they have not found the health system open and transparent Health Service Executive Corporate Plan 2015-2017 11

Goal 4 Engage, develop and value our workforce to deliver the best possible care and services to the people who depend on them Our staff are at the core of the delivery of healthcare services working within and across all care settings in communities, hospitals and healthcare offices. Our Ambition We want to deliver the best possible care to our patients and service users. We will continue to invest in and develop a workforce that is dedicated to excellence, welcomes change and innovation, embraces leadership and teamwork, and maintains continuous professional development and learning. Our approach to developing the workforce extends to our own staff, General Practitioners, Dentists, Pharmacists and those working in the voluntary and non statutory sectors. Evidence shows that happy, well motivated staff deliver better care and that their patients have better outcomes. We will work to make it possible for all staff to do the best job they can and to drive innovation and better care. 12 Health Service Executive Corporate Plan 2015-2017

What We Will Do Develop a People Strategy that will support our wider health reform Build a sustainable and responsive workforce that has the capacity, ability, flexibility and adaptability to meet the changing needs of patients and service users Work to improve communication, consultation and negotiation with staff representative bodies Build management and leadership skills Support and develop education and learning Promote a culture of respect for each other s knowledge and skills Develop our capability through alternative ways of working Support front line staff to contribute to and drive improvement in the care they provide Develop annual work plans that set out the level of staff requirements and skill mix Carry out a staff survey every year How We Measure Success People Strategy developed and implemented Improved recruitment and retention of quality staff A funded workplace plan developed and implemented Personal Development Plans in place for all staff Decrease in staff absence rates in line with international best practice Compliance with the European Working Time Directive Strategic Review of Medical Training and Career Structure (MacCraith Report) implemented Staffing and skill mix recommendations developed and implemented Staff engagement score improves year on year in respect of staff surveys Results from staff surveys acted upon What We Now Know 97,791 whole-time equivalent staff support the delivery of care within the health sector Between September 2007 and the end of 2014 the staff working in the health service reduced by nearly 15,000 or 13% There is a difficulty in recruiting certain staff with particular skills Absence rates stand at 4.27% Level of staff engagement in surveys is lower than we would like Health Service Executive Corporate Plan 2015-2017 13

Goal 5 Manage resources in a way that delivers best health outcomes, improves people s experience of using the service and demonstrates value for money We are working to provide the safest, and most efficient health care system possible for the people in Ireland. Working together with all health care providers and government departments we will use all the resources in the health service in the most efficient and effective way possible to provide quality care and a good experience for those using the service. Our Ambition Changes in technology and the way we communicate have made vast differences to everyone s lives. We need to ensure that we harness the use of technology to deliver better care and to make it more convenient for people to access and use our services. We aim to utilise the advances in technology to provide improved services, improved patient care and better outcomes. Investments in technology will be used to improve operational effectiveness, cost efficiency, transparency and patient safety. Where the health service collects data it will strive to always turn this into information from which clinical insight for patients and clinicians alike can be derived. Where information exists that is useful to the public, it will be made available. We will develop new funding models called activity based funding so that hospitals and community services are funded based on the type, volume, quality and complexity of services they provide and the work they do. We will continue to strengthen governance arrangements through our Service Arrangements to support delivery of quality care and achieve best value for money. We will develop our infrastructural programme including a number of major capital projects which will transform our services for young and old alike. All our investments must have clear benefits, deliver value for money and improve the patient and service user experience in our healthcare system. 14 Health Service Executive Corporate Plan 2015-2017

What We Will Do Work with the Department of Health to develop a commissioning framework for health services Put in place the new finance operating model including implementing a new national integrated financial management and procurement system Implement Activity Based Funding models within the hospital system and commence implementation in community services Establish how best to use funding models to promote integrated care Implement the Health Business Services Strategy with a customer focus Have in place appropriate buildings, assets and capital projects so that they are fit for purpose and in line with how we plan to deliver our services across Community Healthcare Organisations and Hospital Groups Continue to implement major projects, for example the new Children s Hospital new national Maternity Hospital additional Primary Care Centres a national Forensic Mental Health hospital Explore alternative ways to provide new community nursing units to provide stability and sustainability for our older people Implement Value for Money and Policy Review of Disability Services in Ireland in order to deliver community based, person centred models of service for people with disabilities Strengthen accountability with the voluntary agencies funded by the HSE Drive the implementation of ehealth Ireland which is a strategy for Ireland that will improve population wellbeing, health service efficiencies and economic opportunities through the use of technology enabled solutions Implement the Individual Health Identifier Programme so that everyone who needs our services is accurately identified, thereby improving patient safety, efficiencies and effectiveness throughout healthcare Develop new programmes which will change the way we deliver and provide our services by utilising the capability of digital technology, for example: a national computer aided dispatch system for the national ambulance service systems centred on primary care patient management an electronic health record for Ireland digital infrastructure for the delivery of cancer care and ehr technology for workforce management and reporting ereferral from General Practitioner to hospital and eprescribing which will ensure safe quality and cost effective prescribing How We Measure Success Activity Based Funding implemented in all hospitals with efficiencies and increased productivity Activity Based Funding commenced in community services New finance operating model and system progressed Funding model for promotion of integrated care developed and implemented Health Business Services Strategy implemented Capital projects delivered in line with the HSE Capital Programme Annual Compliance Statement and Service Arrangements in place and monitored effectively ehealth Ireland established and delivering new technologies Individual Health Identifiers in place and implemented in priority areas What We Now Know Our budget for 2015 is 12.1 billion which is similar to 2009 despite a growth in population, particularly in people over 65 years of age Over 2,000 non-statutory agencies receive funding to deliver 3.125 billion worth of services We do not have modern, integrated information, workforce and financial systems Other countries spend between 2% and 3% of their health budget each year on ICT Ireland by comparison spends 0.9% There are 2,594 HSE properties which includes hospitals, community healthcare facilities and administration Health Service Executive Corporate Plan 2015-2017 15

Future Health Service Delivery Model Throughout the lifetime of this Corporate Plan, we will fundamentally change the way in which the health service operates by: Creating an empowered and accountable health delivery system through the establishment of Community Healthcare Organisations, Hospital Groups, and the reform of the Primary Care Reimbursement Service and the National Ambulance Service Building and designing models of care which are patient-centred, evidence-based and clinically led across the whole organisation Fostering an environment that supports research and education Reforming the key support functions of Human Resources, Information and Communication Technology, Finance and Health Business Services (Shared Services) A number of key policies and strategies will guide and govern health service delivery over the course of this Corporate Plan. 16 Health Service Executive Corporate Plan 2015-2017 Conclusion This Corporate Plan sets out our ambition across the services, what we will do to achieve this and how we will measure our success. In some cases, in order to deliver our full ambition and to be successful in all our goals, we will require assistance that is external to the organisation through policy, legislative change and additional funding. Annual National Service Plans will provide the details of the actions and resources for each year of the Corporate Plan.

Dr. Steevens Hospital Steevens Lane Dublin 8 Telephone: 01 6352000 www.hse.ie March 2015 ISBN 978-1-906218-88-1 2015 HSE